自体组织盆底重建术治疗盆腔脏器脱垂的疗效观察

Clinical efficacy of pelvic floor reconstruction with autologous tissue in treatment of pelvic organ prolapse

选取2010年1月至2016年12月在温州市人民医院被诊断为盆腔器官脱垂Ⅲ度和Ⅳ度的患者共129例,其中63例进行阴式全子宫切除及自体组织盆底重建术,66例进行传统的阴式全子宫切除及阴道前后壁修补术,评价围手术期及术后各项治疗评价指标的变化及并发症的发生情况。结果显示两组出血量、尿管留置时间、住院时间及肛门排气时间比较,差异无统计学意义(P>0.05)。自体重建组手术时间较传统手术组更长(P<0.05)。自体重建组术后尿道旋转角度、膀胱后角变化及膀胱颈移动度均小于术前(P<0.05),且术后3个月及术后12个月膀胱颈移动度小于传统手术组(P<0.05)。传统手术组术后12个月膀胱颈移动度大于术后3个月(P<0.05)。两组术后12个月盆底影响问卷简表(PFIQ-7)及盆腔器官脱垂/尿失禁性生活简表-12(PISQ-12)评分均低于术前(P<0.05)。两组术后复发率及新发压力性尿失禁发生率比较,差异无统计学意义。提示自体组织盆底重建术后盆底解剖结构稳定性优于传统手术组,尤其是对于重度盆腔脏器脱垂患者。

One hundred and twenty nine patients with pelvic organ prolapse(stageⅢtoⅣaccording to POP-Q staging)diagnosed in our hospital from January 2010 to December 2016 were enrolled,among whom 66 cases underwent vaginal hysterectomy plus vaginal anterior and posterior wall repair(TO group),63 cases underwent vaginal hysterectomy plus pelvic floor reconstruction with autologous tissue(AT group).Clinical parameters,perioperative and postoperative complications were analyzed.There was no statistically significant difference in intraoperative blood loss,indwelling urethral catheter time,length of hospital stay,and anal exhaust time between group AT and group TO(P>0.05).The average operation time of group AT was significantly longer than that of group TO(P<0.05).The postoperative rotation angle of urethra(UR),posterior vesicourethral angle(RVA),and bladder neck descent(BND)of group AT were significantly reduced(P<0.05).The BND of group AT was significantly smaller than that of group TO 3 months and 12 months after the surgery(P<0.05).There was no statistically significant difference in UR before and 12 months after surgery in group TO(P>0.05),while the BND at 12 months after operation in group TO was increased compared to 3 months after operation(P<0.05).There were significant differences in scores of PFIQ-7 and PISQ-12 before surgery and 12 month after surgery in both groups(P<0.05).There was no statistically significant difference between the two groups in the incidence of postoperative recurrence and pressure incontinence(P<0.05).It is suggested that the stability of pelvic floor anatomical structure after pelvic floor reconstruction with autologous tissue is better than that of the traditional surgery,especially for patients with severe pelvic organ prolapse.